How Addressing Drivers of Health Improves Outcomes

Hello, my name is Dr Deborah Rose, and I am the 2024 Physicians Foundation Fellow. I’m a neurologist dedicated to understanding the complex interplay between mental health and neurological health and addressing the drivers of health that impact patient outcomes.

I want to share two patient stories that underscore the importance of addressing drivers of health. These stories really demonstrate how understanding the broader context of a patient’s life can lead to positive outcomes and improved well-being. One of the most challenging aspects of healthcare is recognizing that medical issues often extend beyond physical symptoms.

In my last year of residency, I met Ms. M, who was a 48-year-old woman who presented to our neurology clinic with complaints of a persistent tingling sensation. She described it further as a burning pain underneath her scalp. My immediate initial thought was okay, perhaps this is a neuropathy a problem with her nerves in an uncommon location. Typically, we’ll see neuropathies in the feet due to diabetes or long-term alcohol use most commonly, but Ms. M shared more. She was convinced that a parasite in fact was causing these sensations on her scalp and she reported that this issue began five years ago after a trip to the beach and had since only seen her primary care doctor and a dermatologist to evaluate this problem.

It became clear throughout the visit that her symptoms were psychiatric in nature she described experiencing tactile, auditory and visual hallucinations, believing that she could feel, hear and see this parasite that we weren’t able to see on our examination. She also felt that this parasite was constantly biting her and was even doing so right then and there in the visit. This caused her so much distress that she ended up shaving her head three times in the last five years. Further discussion revealed significant underlying stressors in her life. She unfortunately had a history of domestic violence from her ex-husband and suffered a profound trauma when her younger daughter was kidnapped years ago. These unresolved issues likely contributed to her psychosis as well as continued to impact her ability to maintain employment to ensure housing and food security.

It was crucial to approach this case with sensitivity and avoid triggering further distress. I gently explained to her that her symptoms though they did not have a neurological basis. It was really important for her to seek psychiatric evaluation and treatment. With the support of a dedicated psychiatric and social work team the patient began to address both of her mental health issues and her social needs.

I’d like to share one more case. During my time in residency on the pediatric neurology team, we cared for a 14-year-old boy who was brought to the emergency department by his mother. He had been experiencing hypersomnia or excessive sleeping as well as urinary incontinence during sleep and abnormal movements including eye rolling and jerking of the entire body. The medical team in the emergency department was concerned about a seizure disorder despite an extensive workup and multiple lab tests, including an MRI of the brain and a lumbar puncture or spinal tap. No neurological cause was found. 

Further investigation revealed that the patient had attention deficit hyperactivity disorder (ADHD) and depression with a family history of serious mental health issues including his father’s diagnoses of schizophrenia and bipolar disorder. Additionally, he was a victim of bullying at school, which contributed even further to his stress and exacerbated his symptoms. Recognizing the psychosocial elements at play, we focused on providing comprehensive support. We expedited a sleep study to assess his symptoms more accurately and referred him to a psychiatrist. The psychiatric support, coupled with therapy, helped him and his family better understand his condition. 

This comprehensive approach addressed not only his medical needs but also the significant social and emotional challenges that he faced.

Both of these cases demonstrate the profound impact that addressing drivers of health can have on patient outcomes. 

It’s essential to consider the entire context of a patient’s life, including the psychological social and environmental factors, and by doing so we can provide holistic and effective care that truly supports the whole person.

Let’s continue to strive for a healthcare system that recognizes and addresses the full spectrum of patient needs.